Payor Category model
When creating a target audience, the Payor Category model allows you to evaluate your audience for payor mix and/or use it as a criterion to include/exclude individuals based on the potential for reimbursement.
How payor categories are assigned
Payor assignments differ for patients and non-patients, and are determined by the models using:
- Encounter data from your health system: Assigned for existing patients based on the known payor category associated with their most recent encounter at your health system.
- Predictive logic: Assigned for patients as well as non-patients who don't have history with your health system, based on demographic characteristics.
Each individual in the platform, both patients and non-patients, is assigned to 1 of these 6 categories:
| Code | Category |
|---|---|
| C | Commercial |
| M | Medicare |
| D | Medicaid |
| S | Self-pay |
| O | Other |
| U | Unknown |
The Payor Category model is proprietary to WebMD Ignite.
